Association of the components of the metabolic syndrome with non- alcoholic fatty liver disease among normal-weight, overweight and obese children and adolescents

Abstract

ObjectivesThis study aimed to determine the prevalence of the metabolic syndrome, abnormalities of liver enzymes and sonographic fatty liver, as well as the inter-related associations in normal weight, overweight and obese children and adolescents.MethodsThis cross-sectional study was conducted among a sample of 1107 students (56.1% girls), aged 6-18 years in Isfahan, Iran. In addition to physical examination, fasting blood glucose, serum lipid profile and liver enzymes were determined. Liver sonography was performed among 931 participants. These variables were compared among participants with different body mass index (BMI) categories.ResultsFrom lower to higher BMI category, alanine aminotransferase (ALT), total cholesterol, LDL-cholesterol, triglycerides and systolic blood pressure increased, and HDL-cholesterol decreased significantly. Elevated ALT, aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were documented in respectively 4.1%, 6.6% and 9.8% of normal weight group. The corresponding figure was 9.5%, 9.8% and 9.1% in overweight group, and 16.9%, 14.9% and 10.8% in obese group, respectively. In all BMI categories, ALT increased significantly by increasing the number of the components of the metabolic syndrome. Odds ratio for elevated liver enzymes and sonographic fatty liver increased significantly with higher number of the components of the metabolic syndrome and higher BMI categories before and after adjustment for age.ConclusionsBecause of the interrelationship of biochemical and sonographic indexes of fatty liver with the components of the metabolic syndrome, and with increase in their number, it is suggested to determine the clinical impact of such association in future longitudinal studies.

Early-Onset Metabolic Syndrome in Prepubertal Obese Children and the Possible Role of Alanine Aminotransferase as Marker of Metabolic Syndrome

“…Habitually, in children, NAFLD is asymptomatic, and increased serum of aminotransferase is a predictor of NAFLD [22,62]; however, normal serum levels of these liver enzymes do not exclude the existence of the disease [19,61]. It is reported that hyperinsulinemia plays a significant role in the genesis of fatty liver, and hepatic insulin resistance may be the underlying pathogenetic factor linking obesity and NAFDL [19,63,64,65,66]. Insulin resistance results in increased elaboration of free fatty acids that are absorbed by the liver, with consequent steatosis.…”

The Association of Obesity and Liver Enzyme Activities in a Student Population at Increased Risk for Cardiovascular Disease / Veza Između Gojaznosti I Aktivnosti Jetrenih Enzima U Studentskoj Populaciji Sa Povećanim Rizikom Za Nastanak Kardiovaskularnih Bolesti

“…A major contributor to fatty liver is enhanced de novo synthesis of fatty acids (lipogenesis) which leads to hepatic steatosis. Kelishadi et al (9) suggested that, in future interventional studies, in addition to liver en zymes, high-sensitive CRP, gGT, uric acid, vitamin D, adi ponectin, ghrelin level, insulin level, insulin resistance and the oral glucose tolerance test could be the integral part of the evaluation of patients with NAFLD to further clarify the relationships among different biologic factors and the metabolic syndrome.…”

“…NAFLD includes different types of liver pathologies and outcomes, from simple steatosis to nonalcoholic steatohepatitis (NASH) (9). NAFLD usually develops in children who are obese (10).…”

Non-Alcoholic Fatty Liver and Metabolic Syndrome in Children: A Vicious Circle

“…Kelishadi et al [23] have in fact reported that in 1,107 Iranian subjects (aged 6-18 years) central obesity may be used as a predictor of NAFLD assessed by ultrasound and surrogate markers, such as alanine aminotransferase (ALT). Accordingly, Wei et al [24] have demonstrated that approximately 16% of a cohort of obese British children display an increase of serum ALT levels, elevated BMI and altered glucose homeostasis.…”